Gastroesophageal reflux disease (GERD) is a common and vexing problem. Continuous pH monitoring of upright and supine esophageal acid contact times is considered the gold standard for the diagnosis of GERD. Lifestyle modification is considered the gold standard first line therapy for GERD. However, lifestyle modification is often overlooked and little studied by clinicians despite its inherent advantages of noninvasiveness, ease of implementation, negligible cost, and lack of side effects. In a recent study, we noted a dramatic reduction in supine reflux from baseline in patients fed a refluxogenic meal at 6 pm and retiring at 10 pm. Specifically, a population of 18 severe supine refluxers with baseline ambulatory median supine acid contact time (SACT) of 13.6% underwent repeat pH monitoring under maximally controlled conditions on the CRU. Patients were fed 4 hours before bedtime resulting in a markedly reduced median SACT of 0.5% (p=0.0005). We hypothesize that most supine reflux can be eliminated by this behavioral modification. The current study is a single-blind randomized trial comparing placebo or standard diet (inclusion of evening snack) with lifestyle modification therapy of avoidance of eating for 4 hours before bedtime. Subjects will serve as their own control. Subjects are admitted to the GCRC after a 4 hour fast for each of two overnight study sessions to be performed in random order: one with and one without a refluxogenic evening snack at 9pm, 1 hour before bedtime.